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Regional Manager – Utilization Management
Cleveland ClinicRegional Manager handling Utilization Management, overseeing operations across Cleveland Clinic Florida hospitals. Collaborating with healthcare teams to improve patient outcomes.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, including oversight of clinical operations, compliance with regulatory standards, and performance improvement initiatives. Proficient in managing interdisciplinary healthcare teams and enhancing patient outcomes through effective project coordination and data analysis.
Highest-signal resume keywords
Utilization ReviewHealthcare ManagementClinical Nursing ExperienceProject ManagementRegulatory Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Utilization ManagementClinical NursingData AnalysisPerformance ImprovementConcurrent Review PracticesPayer IssuesRegulatory StandardsEvidence-Based PracticeOutcomes ManagementFinancial Analysis
Soft Skills
LeadershipCollaborationClinical JudgmentCommunicationProblem-Solving
Tools & Technologies
Microsoft OfficeClinical Computer SystemsFinancial Computer SystemsDatabase SystemsOffice Equipment
Certifications & Qualifications
Registered Nurse (RN) LicenseBasic Life Support (BLS)
Industry Keywords
Utilization Review MethodologyAccreditation StandardsHealthcare AdministrationPatient SafetyRisk Management
About the role
Key responsibilities & impact- Oversee daily operations of Utilization Management across the region
- Manage concurrent and retrospective reviews for medical necessity
- Collaborate with interdisciplinary healthcare teams
- Monitor utilization outcomes and lead performance improvement initiatives
- Provide leadership and oversight to Utilization Specialists
- Ensure compliance with nationally recognized screening criteria and regulatory requirements
- Identify opportunities to enhance operational effectiveness and patient outcomes
- Coordinate projects to attain goals
Requirements
What you’ll need- Bachelor's degree in Nursing, Healthcare Administration, or Business Administration
- Completion of an accredited Registered Nursing (RN) Program
- Proficiency with standard office equipment, including copiers, fax machines, personal computers, Microsoft Office, and clinical and financial computer systems
- Three years of nursing clinical experience
- Two years of recent Utilization Review/Care Management experience
- One year of healthcare management experience
- Current valid license in the State of Florida as a Registered Nurse (RN)
- Basic Life Support (BLS) through American Heart Association (AHA) or American Red Cross
- Working knowledge of multiple clinical areas, financial and data analysis, reimbursement practices, preadmission and concurrent review practices
- Advanced understanding of payer issues
- Experience with licensing and accreditation standards, regulatory standards, Utilization Review methodology and theory
- Knowledge of multiple database systems; clinical, financial, and registration
- Advanced knowledge of information, data, and project management
- Advanced knowledge of unit operations, performance improvement/utilization management, regulatory and professional standards, evidence-based practice patient safety/risk management, and outcomes management
- Strong clinical nursing experience and clinical judgment
- Master's degree and demonstrated experience in Project Management, Change Management, and/or Program Development are preferred
Benefits
Comp & perks- Endless support and appreciation
- Investment in health, well-being, and future